曲坦类药物治疗偏头痛患者的急性心肌梗死、心力衰竭和死亡风险。

Risk of Acute Myocardial Infarction, Heart Failure, and Death in Migraine Patients Treated with Triptans.

机构信息

Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.

Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA, USA.

出版信息

Headache. 2020 Nov;60(10):2166-2175. doi: 10.1111/head.13959. Epub 2020 Oct 5.

DOI:10.1111/head.13959

PMID:33017476

Abstract

OBJECTIVE

The goal of this study is to determine the strength of association between treatment with triptans and acute myocardial infarction, heart failure, and death.

BACKGROUND

Case reports in the literature have raised concerns over an association between treatment of migraine headaches with triptans and cardiovascular events. This study aims to systematically evaluate this association in a contemporary population-based cohort. We hypothesized that triptan exposure is not associated with increased cardiovascular events.

METHODS

A retrospective cohort study was conducted within an integrated healthcare delivery system in Southern California. From January 2009 to December 2018, 189,684 patients age ≥18 years had a diagnosis of migraine. In this group, 130,656 were exposed to triptans. Patients treated with triptans were matched 1:1 to those not exposed to triptans by using a propensity score. The primary outcome was acute myocardial infarction; secondary outcomes were heart failure, all-cause death, and combined acute myocardial infarction, heart failure, and death.

RESULTS

The incidence rate of acute myocardial infarction was 0.67 per 1000 person-year in triptan-exposed vs 1.44 per 1000 person-year in not exposed patients. In propensity-matched analyses, the adjusted hazard ratio for triptan exposure was 0.95 (95% confidence interval [CI] 0.84-1.08) for acute myocardial infarction; 1.00 (95% CI 0.93-1.08) for all-cause death; 0.93 (95% CI 0.81-1.08) for heart failure; and 0.99 (95% CI 0.93-1.06) for a composite of acute myocardial infarction, heart failure, or death. Sensitivity analyses focusing on stratified subgroups based on age, gender, ethnicity, and several cardiac risk factors also revealed no significant association between triptan exposure and cardiovascular events.

CONCLUSIONS

No association was found between exposure to triptans and an increased risk of cardiovascular events. These data provide reassurance regarding the cardiovascular safety of utilizing triptans for the medical management of migraine headaches.

摘要

目的

本研究旨在确定曲坦类药物治疗与急性心肌梗死、心力衰竭和死亡之间关联的强度。

背景

文献中的病例报告引发了人们对偏头痛头痛曲坦类药物治疗与心血管事件之间关联的关注。本研究旨在系统评估这一关联在当代人群队列中的情况。我们假设曲坦类药物暴露与心血管事件增加无关。

方法

在南加州一个综合医疗服务系统内进行了回顾性队列研究。2009 年 1 月至 2018 年 12 月期间，189684 名年龄≥18 岁的患者被诊断为偏头痛。在此组中，有 130656 名患者暴露于曲坦类药物。通过倾向评分，将接受曲坦类药物治疗的患者与未暴露于曲坦类药物的患者进行 1:1 匹配。主要结局是急性心肌梗死；次要结局是心力衰竭、全因死亡以及急性心肌梗死、心力衰竭和死亡的合并结局。

结果

暴露于曲坦类药物的患者中，急性心肌梗死的发生率为每 1000 人年 0.67 例，而未暴露于曲坦类药物的患者中为每 1000 人年 1.44 例。在倾向评分匹配分析中，曲坦类药物暴露的调整后风险比为急性心肌梗死 0.95（95%置信区间[CI] 0.84-1.08）；全因死亡 1.00（95%CI 0.93-1.08）；心力衰竭 0.93（95%CI 0.81-1.08）；急性心肌梗死、心力衰竭或死亡的复合结局 0.99（95%CI 0.93-1.06）。基于年龄、性别、族裔和几种心脏危险因素的分层亚组的敏感性分析也显示，曲坦类药物暴露与心血管事件之间无显著关联。